摘要
目的探讨3D打印截骨导板在胫骨远端关节内不规则骨折畸形愈合矫正治疗中的应用价值。方法选取1例后踝骨折线在胫骨远端关节内呈"Z"形走向,波及内踝并使内踝冠状面纵裂的踝关节旋后、外旋Ⅳ度骨折畸形愈合,合并创伤性关节炎患者,将其CT数据在Mimics软件下重建出踝关节三维数据模型,以STL格式输入3D打印机中,打印出实体导板,等离子消毒备用;术中显露骨折部位后,将3枚2 mm克氏针沿定位导板的定位管钻入位于胫骨远端内侧骨折线前方的胫骨中,随后取出定位导板,剥离胫骨远端前方骨膜并将切口牵向前方,将预设在截骨导板上的3个定位孔套入该3枚克氏针,使截骨导板贴合于骨折线前方骨面,顺导板上的3个截骨面将呈"Z"形断面已畸形愈合的内后踝骨块整块截下,复位骨折后以钢板、空心螺钉固定。结果术后X线及CT显示骨折对位对线良好,达到解剖复位,AOFAS评分由术前的25分提升至术后4个月的90分。结论采用个性化设计并3D打印出的截骨导板可以在较小的显露和操作空间内,对缺少表面特征的胫骨远端骨折线实行精确定位,甚至能对关节面为"Z"形骨折线的畸形愈合骨块按原始骨折线进行精准的整块截骨,从而实现骨折解剖复位与内固定。
Objective To evaluate the application of combined navigation templates based on the three-dimensional printing technique in the surgery for distal tibial intra-artieular malunitedfraeture. Methods One patient,who suffered with a completed stage lg pronation-lateral rotation posterior malleolus fracture was ehoieed.In this patient,the fracture line shaped as a Z type,the medial malleoluswas affected and a coronary vertical split formed.Traumatic arthritis has been developed in this ankle.Based on CT data,three dimensional （3D） model of the fractured ankle was reconstructed using the Mimics Software and osteotomy templates were designed.The STL file of the templates were then imported into the 3D printing machine and entity models of osteotomy template were obtained.Which were sterilizated for operation. Following a nice exposure of the fracture cite,three 2-mm K-wires were drilled into the distal medial tibial bone in front of the fracture line under the guidance of a positioning template.After removing the positioning template,striped away the periosteum of the anterior distal tibial and pulled the soft tissue to the front direction.Inserted the three K-wires into the positioning holes on the osteotomy template.Along the three osteotomy planes on the template,the Z shaped mal-united bone block in posterior malleolus was completely resected.Afier a reduction of the fracture, steel plates and hollow screws were used for internal fixation. Results Evaluated from the X-Ray and CT images,satisfactory linear as well as positional alignment was obtained,qualifying the criterion of anatomic reduction.4 months postoperatively,the American Orthopaedic Foot ＆ Ankle Society （AOFAS） score was 90 compared 25 preoperatively. Conclusion Using the three-dimensional printed navigation template,a precise position of the fracture line at distal tibia lacking anatomic structures could be obtained.In the surgery of distal tibial intra-artieular malunited ＂Z＂ shaped fraeture,anentire block in situosteotomy could be accura
出处
《足踝外科电子杂志》
2016年第2期8-14,共7页
Electronic Journal of Foot and Ankle Surgery
基金
江西省科技支撑计划资助项目(20151BBG70119)
